=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295862159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS J GALVON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 11/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4423 POINT FOSDICK NWDR 212
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-1794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-851-8545
-----------------------------------------------------
Fax | 253-851-8644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4423 PT FOSDICK DR NW STE 212
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-1794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-851-8545
-----------------------------------------------------
Fax | 253-851-8644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD00041644
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------